- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.37 / $787.00 / $3,740.00
| Facility | | $96.37 | $787.00 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $2,067.00 / $2,978.00
| Facility | | $1,041.00 | $2,067.00 | $2,978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.42 / $122.65 / $144.74
| Facility | | $89.42 | $122.65 | $144.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.52 / $104.52 / $104.52
| Facility | | $104.52 | $104.52 | $104.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.00 / $950.00 / $11,156.00
| Facility | | $391.00 | $950.00 | $11,156.00 |